Migration-Related Stress Among Haitians: Cross-Cultural Translation of the Demands of Immigration Scale.

Background and Purpose: Although the Haitian population in the United States continues to grow, there is a lack of instruments in Haitian Creole to assess risk factors associated with poor mental health such as migration-related stress. This study described the translation of the Demands of Immigration Scale (DIS) and evaluated psychometric properties, meaning equivalence, and understandability of the Haitian Creole/English DIS. Methods: I applied the Functional Assessment of Chronic Illness Therapy translation procedures and recruited 76 first-generation Haitian immigrants to pilot test the DIS. Results: Reliability was strong (α > .93). Meaning equivalence was maintained (r = .979), 75% understood both DIS versions equally, and 80% rated the translation as excellent/good. The DIS significantly correlated with gender, income, age, age at migration, English fluency, and depression. Conclusions: The DIS can reliably identify immigration-related social determinants of mental health and is ready for use in Haitian Creole.

Confronting mental health stigma in Haitian Americans suffering from mental health challenges.

BACKGROUND: Haitian Americans have been disproportionately exposed to risk factors known to play a significant role in the development of mental illness. Yet despite the documented effectiveness of mental health treatment, a high proportion of Haitian Americans with mental health disorders have not received care. LOCAL PROBLEM: Internalized stigma of mental illness (ISMI) was reported as one of the primary reasons Haitian Americans do not seek help for mental illnesses, resulting in poor long-term outcomes for individuals and families in this community. This quality improvement project characterized ISMI among Haitian Americans, examined associated demographic factors, and tested the impact of a culturally relevant ISMI educational video intervention on willingness to seek mental health treatment. METHODS: Haitian Americans who self-reported mental illness (N = 20) were recruited from a South Florida clinic. Descriptive statistics, correlations, and thematic analyses were completed to analyze the data. INTERVENTIONS: Participants completed the nine-item ISMI scale, watched an educational video about ISMI, completed a post-intervention survey, and engaged in conversations about mental health and ISMI. RESULTS: Sixty-five percent of participants reported mild levels of ISMI. Sex was significantly correlated with ISMI (r = -0.458, p = .042); male participants experienced higher levels of ISMI. The educational video improved participants' knowledge of ISMI, and 85% indicated increased willingness to seek treatment. CONCLUSIONS: When caring for Haitian Americans with mental illnesses, nurse practitioners should initiate conversations about ISMI, consider gender differences in mental illness beliefs and attitudes, and provide culturally responsive psychoeducational interventions to promote more mental health treatment utilization.

Perceived Success After Participation in the Summer Health Professions Education Program.

Importance: The number of active health care professionals has not kept pace with the increasing number of minoritized individuals in the US. The Summer Health Professions Education Program (SHPEP) was developed to alleviate this underrepresentation in the health workforce. Objective: To evaluate students' changes in perceived barriers and motivators for entering and succeeding in professional school after SHPEP participation. Design, Setting, and Participants: For this cohort study, anonymous electronic surveys were sent to the 2017 to 2021 SHPEP participants at an academic health center at a large university in the southern US. Participants were first- and second-year undergraduates interested in the health professions and enrolled in the SHPEP. Program participants were invited to complete the study. Exposures: An anonymous electronic survey was administered before and immediately after program completion. Main Outcomes and Measures: The SHPEP Career Barriers Survey (SCBS) is composed of 22 questions on motivators and 20 questions on barriers to entering and succeeding in health professional school. Students responded using a 5-point Likert scale, with 1 indicating strongly disagree and 5 indicating strongly agree. Mixed analysis of variance was used to analyze the program's latent factors. Results: Of all 402 SHPEP participants (mean [SD] age, 19.32 [0.88] years) from 2017 to 2021, 325 completed the preprogram survey and 259 also completed the postprogram survey. Of the 325 initial participants, 4 identified as American Indian or Alaska Native, Native Hawaiian, or Pacific Islander (1.2%); 12 as Asian (3.7%); 188 as Black (57.8%); 95 as Hispanic or Latino (29.2%); 7 as White (2.2%); and 16 as multiracial (4.9%). Two hundred twelve participants were female (65.2%), and 226 were first-generation college students (69.5%). Results of the SCBS indicate that the SHPEP had a significant small to moderate association on perceived motivators (mean [SD] x̅ = 84.60 [9.67] vs 80.95 [8.93]; P = .001) and decreases in perceived barriers (mean [SD] x̅ = 48.02 [13.20] vs 51.72 [11.39]; P = .008). There was no significant difference in program success between studied years. Conclusions and Relevance: In this cohort study, the SHPEP appeared to provide essential support for underrepresented students as measured by improved perceived motivators and reduced perceived barriers to entering professional education. Knowledge from this study can assist educators and health care professionals who wish to implement similar enrichment programs.

Feasibility of the Palliative Care Education in Assisted Living Intervention for Dementia Care Providers: A Cluster Randomized Trial.

BACKGROUND AND OBJECTIVES: Alzheimer's disease and related dementia (ADRD) is a major cause of death in the United States. While effective interventions have been developed to deliver palliative care to nursing home residents with ADRD, little work has identified effective interventions to reach assisted living (AL) residents with dementia. RESEARCH DESIGN AND METHODS: One hundred and eighteen AL residents with dementia from 10 different ALs in Florida participated. A pilot study using a cluster randomized trial was conducted, with 6 sites randomized to receive a palliative care educational intervention for staff (N = 23) to deliver care to residents; 4 sites were usual care. The feasibility of the intervention was assessed by examining recruitment, retention, and treatment fidelity at 6 months. Cohen's d statistic was used to calculate facility-level treatment effect sizes on key outcomes (documentation of advance care planning [ACP] discussions, hospice admission, and documentation of pain screening). RESULTS: The intervention proved feasible with high ratings of treatment fidelity. The intervention also demonstrated preliminary evidence for efficacy of the intervention, with effect sizes for the treatment group over 0.80 for increases in documentation of ACP discussions compared to the control group. Hospice admissions had a smaller effect size (0.16) and documentation of pain screenings had no effect. DISCUSSION AND IMPLICATIONS: The pilot results suggest that the intervention shows promise as a resource for educating and empowering AL staff on implementing person-centered palliative care delivery to persons with dementia in AL. A larger, fully powered randomized trial is needed to test for its efficacy.

The intersection of social determinants of health, the microbiome, and health outcomes in immigrants: A scoping review.

In the present scoping review, we explore whether existing evidence supports the premise that social determinants of health (SDoH) affect immigrant health outcomes through their effects on the microbiome. We adapt the National Institute on Minority Health and Health Disparities' research framework to propose a conceptual model that considers the intersection of SDoH, the microbiome, and health outcomes in immigrants. We use this conceptual model as a lens through which to explore recent research about SDoH, biological factors associated with changes to immigrants' microbiomes, and long-term health outcomes. In the 17 articles reviewed, dietary acculturation, physical activity, ethnicity, birthplace, age at migration and length of time in the host country, socioeconomic status, and social/linguistic acculturation were important determinants of postmigration microbiome-related transformations. These factors are associated with progressive shifts in microbiome profile with time in host country, increasing the risks for cardiometabolic, mental, immune, and inflammatory disorders and antibiotic resistance. The evidence thus supports the premise that SDoH influence immigrants' health postmigration, at least in part, through their effects on the microbiome. Omission of important postmigration social-ecological variables (e.g., stress, racism, social/family relationships, and environment), limited research among minoritized subgroups of immigrants, complexity and inter- and intra-individual differences in the microbiome, and limited interdisciplinary and biosocial collaboration restrict our understanding of this area of study. To identify potential microbiome-based interventions and promote immigrants' well-being, more research is necessary to understand the intersections of immigrant health with factors from the biological, behavioral/psychosocial, physical/built environment, and sociocultural environment domains at all social-ecological levels.

Social Determinants of Health Among Pregnant Hispanic Women and Associated Psychological Outcomes.

BACKGROUND: There has been a concerning surge in maternal mortality among Hispanic women in recent years. Compromised mental health is present in nearly half of all maternal deaths, and risk factors include poor social support and depression. OBJECTIVE: Among Hispanic women who were born in the USA versus those not born in the USA, we sought to describe and compare social determinants of health and maternal psychological outcomes. METHODS: Hispanic pregnant women (n = 579) were recruited from two clinics in Tampa, FL, and completed various questionnaires related to social determinants of health, depression, stress, and social support. STATISTICAL ANALYSIS: Descriptive statistics, t-tests, and chi-square analyses were used to compare relationships between maternal nativity and subsequent psychosocial outcomes. Pearson correlations were used to explore associations between variables. RESULTS: Hispanic pregnant women who were not born in the USA had lower incomes (χ2 = 5.68, p = 0.018, df = 1), were more likely to be unemployed (χ2 = 8.12, p = 0.004, df = 1), and were more likely to be married (χ2 = 4.79, p = 0.029, df = 1) when compared with those born in the USA. Those not born in the USA reported lower social support (t = 3.92, p<0.001), specifically the tangible (t = 4.18, p < 0.001) and emotional support subscales (t = 4.4, p<0.001). When compared with those born in the USA, foreign-born Hispanic women reported less stress (t = 3.23, p = 0.001) and depression (t = 3.3, p = 0.002). CONCLUSION: Pregnant Hispanic women not born in the USA are at increased risk for suboptimal social determinants of health, including less social support. US-born women were more stressed and depressed and had higher BMIs.

Strès ak Pwoblèm Pap Janm Fini: Deciphering migration-related stress from the perspectives of Haitian immigrants in Florida.

Relocating and starting a new life in a foreign country may entail a constellation of new stressors for Haitian immigrants; thus, research that enhances our understanding of how this vulnerable population contextualizes migration-related stress is necessary. The objectives of this study were to: (a) identify what factors are associated with migration-related stress, and (b) describe which and why specific migration-related stressors were most significant from the perspective of those suffering from high migration-related stress post migration via the stress proliferation lens of the stress process model. In this mixed-methods, sequential, explanatory pilot study, first-generation Haitian immigrants (N = 76) were recruited to operationalize migration-related stress, using the Demands of Immigration Scale (DIS). Participants (n = 8), who scored 25 or higher on the DIS, completed an in-depth audio-recorded follow-up interview that consisted of open-ended questions and a stressor-ranking questionnaire. Descriptive statistics, Pearson correlations, multiple linear regression (quantitative), and thematic analysis with a double-coded approach (qualitative) were employed to analyze the data. Female gender, older age, English fluency, and migration after the age of 18 years were associated with higher migration-related stress. However, only gender and English fluency predicted migration-related stress. In interviews, participants ranked five migration-related stressors as most stressful: language barriers, financial strains, loss of social networks, family conflicts, and exposure to discrimination/stigma. A nuanced depiction of migration-related stressors and proliferation mechanisms of migration-related stress may help identify areas where support and preventive efforts should be directed to improve social integration, stress levels, and mental well-being among immigrants.

Comparative analysis of COVID-19 guidelines from six countries: a qualitative study on the US, China, South Korea, the UK, Brazil, and Haiti.

BACKGROUND: In late January, a worldwide crisis known as COVID-19 was declared a Public Health Emergency of International Concern by the WHO. Within only a few weeks, the outbreak took on pandemic proportions, affecting over 100 countries. It was a significant issue to prevent and control COVID-19 on both national and global scales due to the dramatic increase in confirmed cases worldwide. Government guidelines provide a fundamental resource for communities, as they guide citizens on how to protect themselves against COVID-19, however, they also provide critical guidance for policy makers and healthcare professionals on how to take action to decrease the spread of COVID-19. We aimed to identify the differences and similarities between six different countries' (US, China, South Korea, UK, Brazil and Haiti) government-provided community and healthcare system guidelines, and to explore the relationship between guideline issue dates and the prevalence/incidence of COVID-19 cases. METHODS: To make these comparisons, this exploratory qualitative study used document analysis of government guidelines issued to the general public and to healthcare professionals. Documents were purposively sampled (N = 55) and analyzed using content analysis. RESULTS: The major differences in the evaluation and testing criteria in the guidelines across the six countries centered around the priority of testing for COVID-19 in the general population, which was strongly dependent on each country's healthcare capacity. However, the most similar guidelines pertained to the clinical signs and symptoms of COVID-19, and methods to prevent its contraction. CONCLUSION: In the initial stages of the outbreak, certain strategies were universally employed to control the deadly virus's spread, including quarantining the sick, contact tracing, and social distancing. However, each country dealt with differing healthcare capacities, risks, threats, political and socioeconomic challenges, and distinct healthcare systems and infrastructure. Acknowledging these differences highlights the importance of examining the various countries' response to the COVID-19 pandemic with a nuanced view, as each of these factors shaped the government guidelines distributed to each country's communities and healthcare systems.

Stress and depression in the context of migration among Haitians in the United States.

Our global communities are becoming increasingly more diverse and interwoven; thus, research that enhances our understanding of the multidimensional relationship between depression and migration among distinct ethnic groups is imperative. This study examined the relationship between migration-related stress and depression and the extent to which that relationship is modified by other factors, through the lens of the stress process model. This cross-sectional pilot study used purposive sampling methods to recruit 76 first-generation Haitian immigrants living in South and West Florida from February 2018-May 2018. Descriptive statistics, bivariate and multiple regressions were utilized to assess associations among migration-related stress (Demands of Immigration Scale), depression (Center for Epidemiological Studies Depression (CESD), Zanmi Lasante Depression Symptom Inventory (ZLDSI)), and key demographic variables. Findings showed a strong positive correlation between migration-related stress and depression (CESD (ß =.606, 95% CI [.296, .556]) and ZLDSI (ß = .624, 95% CI [.242, .440]). Relative to the standardized coefficient, migration-related stress was the strongest predictor of depression after controlling for other predictors. Presence at the 2010 earthquake was the only significant moderator, showing an amplifying effect between migration-related stress and depression (ZLDSI) for those in Haiti during the 2010 earthquake. Consideration of pre-migration factors and the degree of migration-related stress encountered while adapting to life post-migration is critical because they play a significant role in shaping immigrants' depression realities. Community-based services that incorporate or partner with established immigrants to strengthen support for the most vulnerable immigrants early on after migration could serve to mitigate migration-related stressors and facilitate mental health promotion and prevention.

Esforços, sacrifícios e liderança heróicos: é tudo em um dia de trabalho para os enfermeiros antes, durante e após a crise do COVID-19 / Heroic efforts, sacrifices and leadership: it's all in a day's work for nurses before, during, and after the COVID-19 crisis / Esfuerzos heroicos, sacrificios y liderazgo: todo es un día de trabajo para las enfermeras antes, durante y después de la crisis de COVID-19

O novo coronavírus SARS-CoV-2 que surgiu na cidade de Wuhan, na China, no ano passado, produziu uma pandemia de coronavírus em larga escala (COVID-19). Enquanto escrevemos isso, em todo o mundo existem mais de um milhão de casos e o número de mortos chegou a mais de 100.000 pessoas. No Brasil e em outros países, alguns indivíduos teorizaram que o vírus foi "criado" em laboratórios, e alguns grupos religiosos levantaram a ideia de que o vírus sinalizava o início do apocalipse. No entanto, um estudo científico recente concluiu que o vírus é o produto da evolução natural, encerrando qualquer boato sobre engenharia genética deliberada. No Brasil, o COVID-19 foi diagnosticado pela primeira vez em 26 de fevereiro e já se espalhou por todos os estados e territórios.

The novel SARS-CoV-2 coronavirus that emerged in the city of Wuhan, China last year has produced a large-scale coronavirus (COVID-19) pandemic. As we are writing this, across the world there are more than a million cases, and the death toll has reached more than 100,000 people. In Brazil as well as other countries, some individuals theorized that the virus was "created" in laboratories, and some religious groups raised the idea that the virus signaled the onset of the apocalypse. However, a recent scientific study has concluded that the virus is the product of natural evolution, ending any rumor about deliberate genetic engineering. In Brazil, COVID-19 was first diagnosed on February 26th and has already spread throughout all the states and territories.

El nuevo coronavirus SARS-CoV-2 que surgió en la ciudad de Wuhan, China, el año pasado produjo una pandemia de coronavirus a gran escala (COVID-19). Mientras escribimos esto, en todo el mundo hay más de un millón de casos, y el número de muertos ha llegado a más de 100,000 personas. En Brasil, así como en otros países, algunas personas teorizaron que el virus fue "creado" en laboratorios, y algunos grupos religiosos plantearon la idea de que el virus señalaba el inicio del apocalipsis. Sin embargo, un estudio científico reciente ha concluido que el virus es el producto de la evolución natural, poniendo fin a cualquier rumor sobre ingeniería genética deliberada. En Brasil, COVID-19 fue diagnosticado por primera vez el 26 de febrero y ya se ha extendido a todos los estados y territorios.

A biobehavioral approach to understanding obesity and the development of obesogenic illnesses among Latino immigrants in the United States.

The prevalence of obesity and obesity-related illnesses is higher among Hispanics (Latinos) than other racial and ethnic groups, and rates increase exponentially with the number of years living in the United States. Mounting evidence suggests that the origins of many chronic illnesses among disadvantaged minority groups may lie with cumulative exposure to chronic psychological and physiological stressors through the biobehavioral process of allostatic load (AL). Among immigrant Latinos, acculturation stress may contribute to an increase in AL and thus may be an independent risk factor for the development of obesity and obesogenic illnesses. The purpose of this theoretical article is to present a proposed model of the effects of acculturation stress on AL and obesity among Latino immigrants. Such a model can be useful to guide intervention efforts to decrease obesity among immigrant Latinos by adding education, skill building, and social integration strategies to healthy eating and physical activity to reduce the deleterious impact of acculturation stress.